MEDICARE: DR. MICHAEL SEAN TODD DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	015815	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	431734574	OTHER	MO	COMPANY TAX ID

General Provider Information

NPI Number	:	1437151750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SEAN TODD DMD

Provider Business Mailing Address
First Line	:	1500 VANDIVER
Second Line	:	SUITE 104
City	:	COLUMBIA
State	:	MO
Zip	:	65202
Country	:	US
Telephone Number	:	573-814-1694
Fax Number	:	573-814-2845

Provider Business Practice Location Address
First Line	:	1500 VANDIVER
Second Line	:	SUITE 104
City	:	COLUMBIA
State	:	MO
Zip	:	65202
Country	:	US
Telephone Number	:	573-814-1694
Fax Number	:	573-814-2845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	09/30/2008

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